by Shawn Kirby L.Ac.

Noted chef and raconteur Anthony Bourdain once made the comment that, “it takes a special person to do the very basic things correctly.” And while Tony was talking about haute cuisine, the same holds true in our profession, which brings me to the topic of today’s blog – needling. Let’s be honest. Just about anyone aided by a guide tube and super slick needle made in an ultramodern facility can slap in an acupuncture needle and more or less get the job done. The question is, do you want to be average? Or do you want to excel?

The two basic principles that I’m going to give you are universal principles that will make you a better acupuncturist regardless of the tradition of acupuncture you subscribe to. Whether you go gonzo with a 30 gauge needle at Stomach 36 performing 20 straight minutes of “fire on the mountain” technique or you’re a meridian therapy practitioner using 00 gauge Seirins, the basic goals of needling remain the same. You need to be able to find the point you wish to needle as accurately as possible, and you need to be able to achieve de qi. These principles will help you do this with every patient, every time.

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#1. Be Present

The first and biggest stumbling block to needling well is the western student’s preoccupation with making acupuncture as esoteric and ethereal as possible. The most basic and fundamental paradox of needling is simply this: the more you pay attention to what you're doing in a real physical sense, here in the real physical world, the more you will be able to “access the qi.” Conversely, the more you try to needle through ESP or some kind of otherworldly and ghostly sense, the more into your head you will get and the worse your needling skills will become. In order for you to work effectively, you need to be, first and foremost, present in reality and in residence in your own body. To use the new-age parlance, you need to be grounded.

Personal disembodiment and its corresponding assumption that needling is an esoteric or “energetic” discipline leads to a lot of poor needling. This is because the practitioner becomes obsessed with trying to make what they are doing adhere to some mental projection of what they think acupuncture should be, all the while failing to notice what’s really going on under their hands. Needling is a physical activity, not a mental exercise, and in order to needle effectively you need to be present in physical reality.

This is not a new idea. Being in your body and being present while needling are foundational concepts in the classic literature of our medicine.

The ninth chapter of the Vital Access states, “When inserting the needle, do not look, do not listen, do not speak, and do not move. Simply pay close attention and focus on the tip of the needle to feel for the coming and going of qi.” 1

Acupuncture master Yanagiya Sorei describes it this way:

“When practicing [acupuncture] one must be very strict about one’s attention, breathing, and posture. [The dan tien] must be filled and the eyes must be half closed, as if in a Zen meditation hall. One must forget about time and fix all of one’s attention on the needle. Even a mosquito, when it is about to bite, assumes a special stance, tenses its legs, places its proboscis on the skin, and inserts it with utmost care.” 2

How do you cultivate an embodied state? Well, there are all kinds of ways to do it, but the simplest way to start is to begin your day (or your working day) by doing something physical. Take a walk (walk, don’t stroll around thinking). Roll around on the floor, do some hatha yoga, have the massage therapist that you share your clinic with give you a massage or, my personal favorite, eat a hamburger. (Maybe you’ve noticed, but people who live on tofu and sprouts tend to be a little, as we say in the business, “ungrounded.”)

If you would like more specific exercises in working with being fully embodied, I highly recommend Reggie Ray’s “Meditating with the Body” CDs and his new book “Touching Enlightenment” available from SoundsTrue.

#2. Location, location, location

Now that you’re present and in your body, you will be able to achieve your next task, which is to locate the point you wish to needle. The more present you are and the more you use your physical awareness, the better you will be able to do this. The more precise your point location is, the better your needling will be. This isn’t a complex skill, but it takes a great deal of concentration and experimentation to get it right.

The first step in finding a point is learning the textbook location, including the appropriate cun measurements. You noticed that I said the first step. Most people end there and, consequently, never get close. As one of my Japanese meridian teachers put it in his usual succinct manner, “cun counters suck.” A difference of a few centimeters can mean the difference between getting de qi and shining yourself on. You need to be able to feel where the point is, and then put your needle right at the epicenter of the point, not one centimeter away in either direction. All that you need to do to accomplish this level of exactness is to use your tactile sense and feel the living tissue beneath your hand. Your patient’s physical body will tell you everything you need to know.

A classical acupuncture point, particularly the antiquity points and the back-shu points, can be found by feeling for physical differences in the skin near where the point should be found according to cun measurements. First and foremost, the point will present itself as a divot or depression in the tissue distinct from the surrounding area. The tip of your index finger should drop right into the point and stay there. Secondarily, you should feel a change in the quality of the tissue. Most often it will feel cooler, dryer and perhaps have slightly scaly skin. Try this with your own SP 6 and you’ll see what I mean.

When needling, I follow Miki Shima’s example and locate the point with my left index finger. I then roll the finger away, keeping the edge of the finger next to the point and carefully place the guide tube at the epicenter of the point with my right hand. I then take my left thumb and grasp the guide tube, never having moved my left index finger other than to roll it away to reveal the point beneath. This is a stylistic point, however, and not a requirement. As long as you put the needle on the exact position at the epicenter of the point, you will get de qi.

As far as ashi points are concerned, they can be anything from a generalized tenderness to a knot in a muscle. You can, of course, put an acupuncture needle anywhere you want as long as you have a reasonable purpose in doing so. The one thing you don’t want to do, but which I constantly see acupuncturists doing, is repeatedly jabbing your patients with your index finger and asking, “Does this hurt, does this hurt, does this hurt…?”

Don’t do that. Seriously. It is intensely annoying to the person receiving it. Use your whole hand, or both hands, and really try and feel the physical tissue beneath. What do you feel? Can you differentiate between muscle tissue, organs, connective tissue, and so on, by feel alone? You should be able to. You should strive, at all times, to have at least as good a quality of touch as a massage therapist, if not better. My Japanese meridian therapy teacher had to treat exclusively with shiatsu for a year before he was allowed to touch a needle. If tui na and shiatsu weren’t a part of your training, then get thee to a bodywork class ASAP.

If you find the point accurately and pay attention to your angle of insertion, you will get de qi. The idea that the only way to accomplish this is to use a thick needle is a product of poor technique. If the only way that you can get de qi is by using a needle the thickness of a carpenter’s nail, you need to work on your point location regardless of whether you like to perform Chinese style needling or not. I have seen our local sports medicine acupuncture legend, Whit Reeves, get de qi akin to sticking a spoon in a light socket using nothing more than a red Seirin. With acupuncture, just like real estate, it’s all about location, location, location.

Conclusion

You have to be present, grounded and focused or your scattered mind and disembodied touch will do your patient more harm than good. These skills are something that can be learned and utilized quickly, but take a lifetime to perfect. Tiger Woods, at a high point in his career, deliberately changed his swing. He did so because he wanted his swing to be as technically perfect as possible. He struggled for awhile after making this change, but it paid off huge dividends in the long run. Similarly, Shudo Denmai has spent the entirety of his career perfecting his needling technique - and he's still working on it. That's what Tony Bourdain was talking about. To get the simple things right does take a special kind of person. The kind of person who is obsessed with honing their skills to a razor edge, never accepting mediocrity. You know... you.

Notes
1 Finding Effective Acupuncture Points, by Shudo Denmai, Eastland Press, 2003 pg 239
2 ibid